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Insights into Imaging
Fig. 20 | Insights into Imaging

Fig. 20

From: Early cross-sectional imaging following open and laparoscopic cholecystectomy: a primer for radiologists

Fig. 20

After recent elective laparoscopic cholecystectomy, low-output bile loss from drainage and small-sized biloma in the gallbladder fossa (not shown) persisted despite percutaneous treatment with the positioning of a plug and absent biliary leakage at cholangiography (a) from percutaneous transhepatic biliary drainage (PTBD) (thick arrow). Gadoxetic acid-enhanced MRCP (b, coronal MIP reconstructed image) showed active leakage of enhanced bile at the origin of the 6th segment branch, excluded by the plug. Note hyperintensity along the PTBD (thick arrow) yielding bile. Repeated percutaneous cholangiography (c, black thick arrow) directed to the 6th segment branch confirmed leakage (arrow). Embolisation with glue (Glubran 2, GEM, Viareggio, Italy) plus Lipiodol ultimately allowed resolution of the fistula

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